Patient Positioning
POSITION WHAT WHEN
During episodes of
respiratory distress, when
HOB 60-90° with the
inserting a nasogastric tube,
patient sitting up in bed
during oral intake with
feeding precautions
HIGH-FOWLERS
Facilitates chest expansion so
it is helpful with patients who
are having difficulty breathing,
HOB 45-60° with the during tube feeding
patient sitting up in admininstation because it
bed. Patient lying on facilitates peristalsis while
their back in bed, with minimizing aspiration risk,
HOB reclined simply a comfortable position,
FOWLER'S also used in the postpartum
period to facilitate excretion
of lochia
Necessary in some
neurological and cardiac
conditions, after procedures
HOB 15-30° with patient or surgeries to facilitate
lying on their back hemostatis at the insertion
site (like a cardiac cath with
SEMI FOWLER'S a femoral approach) or
drainage from various drains
Post procedures to maintain
HOB flat, patient on hemostatis at insertion site,
frequent position for many
back
SUPINE surgeries
Not used frequently; use as a
HOB flat, patient on therapeutic measure in
stomach with head to advanced ARDS, during and
PRONE one side after some surgeries
During CVC (subclavian or IJ)
placement, if an air embolism
is suspected as it traps air in
the right ventricle, when
Flat on back, feet raised
positioned this way with a
higher than head by
Valsava it can convert
15-30°
TRENDELENBERG supraventricular tachycardia,
during various surgeries,
respiratory distress to
increase perfusion
For some surgeries or
procedures, pre-surgery
intervention for some
Flat on back, head vascular surgeries, may be
raised higher than feet
used to facilitate respirations
REVERSE by 15-30° in patients who need to lay
TRENDELENBERG flat post-procedure, reduces
GERD symptoms
NURSING CONCERNS ADDITIONAL NOTES
This may be uncomfortable to
maintain for an extended period, a
patient may slump over if they lack
the strength to stay sitting upright,
May need to float heels, knees can
and must be repositioned within 2
be bent or straight
hours to prevent skin breakdown if
patient is unable to reposition
themselves as High-Fowler's places
quite a bit of pressure on the coccyx
May need to float heels, knees can
Minimal be bent or straight, may be called
Standard Fowler's
If a patient has continous tube
feeding infusing or trouble
managing secretions, aspiration is a May need to float heels
risk with prolonged positioning
Many pressure points (including the
top of toes from the sheet) therefore
you must be diligent in turning
patient, may be uncomfortable to
-
maintain, increases apnea in OSA,
avoid after 1st trimester due to the
added pressure on vena cava and
subsequent hypotension
Not comfortable for long, difficult
for full respiratory expansion, not
easy to put a patient into this -
position (especially if they have
multiple lines and tubes)
Frequently used by nurses during
instances of hypotension, however
evidence does not support this
practice:
Not ideal with increased ICP,
https://www.annanurse.org/downlo
uncomfortable, if patient is
ad/reference/practice/tripTrendelen
confused putting them in this
burg.pdf also this link:
position may increase fall risk.
http://www.bestbets.org/bets/bet.p
hp?id=1710 Recommends using a
passive leg raise to give a small
bolus to the patient from their own
circulation in legs
Somewhat uncomfortable, if
patients are confused it might be
-
difficult to maintain them safely in
this position for long periods
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Patient Positioning
POSITION WHAT WHEN NURSING CONCERNS ADDITIONAL NOTES

Flat on back, knees

bent, rotated outwards, During or after various
feet flat on the bed Minimal -
surgeries, for comfort
(head/shoulders
DORSAL typically on a pillow)
RECUMBENT

Relieves pressure on saccrum,

great for patients who are
immobile as it is typically
On side, top knee and
quite comfortable and May specificy a side, "place the
arm flexed and Minimal
provides good spine patient in left lateral position"
supported by pillows
alignment, supporting and
LATERAL off-loading common pressure
points

Occasionally used with

unconcious patients as it
facilitates drainage of oral
Halfway between lateral secretions, pregnancy, during Must remember to turn patient on
schedule -
and prone enemas, for patients who are
paralyzed as it takes
SIM'S pressure off of the hip and
saccrum

Facilitates respiratory
Ensure patient can safely sit back in
expansion, makes it easier to
Sitting at the side of the bed; don't leave unattended if a fall
breath in patients with -
bed, leaning over a table risk and sitting at the side of the
respiratory difficulty, and
bed
ORTHOPNEIC used during a thoracentesis

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